Endocrine (27)

Question 1

fluorescein angiography diagnoses ____ (sx: bleeding that causes sensation of falling curtain obstructing visual fields or eye floaters)?

Answer 1

diabetic retinopathy (**asx early in dz —> falling curtain sensation meaning vitreous bleed —> floaters that represent resolution of the bleed)

Question 2

Lens refraction tests?

Answer 2

myopia (near sightedness), hyperoptia (far sightedness), astigmatism (irregular curvature of lens)

Question 3

fluorescein staining dx what three things?

Answer 3

corneal abrasions, ulcers, infection (HSV, CMV)

Question 4

how does fluorescein angiography work?

Answer 4

elucidate microaneurysm formation and neovascularization.

Question 5

Subacute thyroiditis:

Phase 1: ____ wks of painful thyromegaly and hyperthyroidism. (inflammation induced release of thyroxine —> incr TSH)
Phase 2: ____wks asx, euthyroid
Phase 3: _____ time of hypothyroid (burnout of thyroid gland)

Answer 5

1 - 3-6wks
2 - 1-3 wks
3 - wks to mo

Question 6

thyroid peroxidase antibody found in___ (a hypothyroid)

Answer 6

hashimoto thyroiditis

Question 7

thyroid stimulating immunoglobulin is found in ____ (hyperthyroid)

Answer 7

grave’s disease

Question 8

First step in tx of pt with pH 7.26, antion gap metabolic acidosis, elevated serum beta-hydroxybutyrate and urine ketones

Answer 8

this is alcoholic ketoacidosis:

1. tx with thiamine
2. NS and dextrose

Question 9

how do you dx anaplastic thyroid carcinoma?

Answer 9

open surgical biopsy

Question 10

mets of anaplastic thyroid carcinoma

Answer 10

LBB - lungs, bone, brain

Question 11

MOA of metformin

Answer 11

1. decreases hepatic gluconeogenesis

2. increases insulin sensitivity in peripheral tissues

Question 12

CI to metformin:

Cr >____ in M or ____ in F.

Answer 12

1. 5mg/L

1. 4mg/L

Question 13

insulin, loops, reisns, alkalinizing agents, and Beta agonists (i.e. inhaled or systemic) are good for what ion abnormality?

Answer 13

good for reducing potassium, may cause hypokalemia.

Question 14

Name the four ways of DM dx?

Answer 14

1. fasting bs > or = to 126 on two occasions
2. HbA1c > or = to 6.5% on two occasions
3. 2 hr post oral GTT of bs > or = 200
4. a random bs > or = 200 in a pt that already has sx

Question 15

self limiting, rapid growing painless mass w/ or w/o sx of obstruction in neck. ey/hypo/hyerthyroid.

dx procedure?
dx?

Answer 15

open surgical biopsy to dx Reidel thyroiditis.

distinguish it from malignant anaplastic thyroid carcinoma

Question 16

function of PTH

Answer 16

keep enough Ca in blood - release from bone

Question 17

parathyroid, pancreatic, pituitary adenoma =

Answer 17

MEN1

Question 18

mucosal neuromas, marfanoid, pheochromo, medullary thyroid ca = ?

Answer 18

MEN 2b

Question 19

parathyroid hyperplasia, pheo, medullary thyroid Carcinoma

Answer 19

MEN 2a

Question 20

What does this outcome of HD-dexamethasone test mean?

ACTH undetectable and cortisol not suppressed

Answer 20

Primary hypercortisolism (tissue producing cortisol w/o regulation or ACTH stimulation)

Dx: HD-dex suppression test

Question 21

What does this outcome of HD-dexamethasone test mean?

ACTH elevated and cortosol not suppresed

Answer 21

ectopic ACTH production (Cushing’s syndrome) –> paraneoplastic syndrome producing ACTH

Dx: Chest CT and abd CT

Question 22

two cancers that cause paraneoplastic syndrome producing ACTH.

Answer 22

adrenocortical carcinoma

small cell lung carcinoma

Question 23

What does this outcome of HD-dexamethasone test mean?

high-normal ACTH and suppressed cortisol

Answer 23

ACTH pit adenoma (B9 tissue producing too much ACTH) –> cushing disease

(Dx: pit MRI)

Question 24

first step in dx euthyroid pt (normal TSH) with thyroid nodule

Answer 24

FNA to distinguish b/w B9 and malignant thyroid tumors

Question 25

if thyroid nodule is found and TSH is low, what are the three findings of a radioactive iodine?

Answer 25

hot - increased activity (B9)

warm - same uptake as surrounding tissues –> FNA next

cold - decreased uptake –> FNA next

Question 26

First line medication for prevention of progression in a person with a T score of below -2.5 (or @risk -1.5 to -2.4)

Answer 26

osteoporosis DoC tx bisphosphonate (ibanDRONATE) for TX and PREVENTION

or

denosuMAB

Question 27

vitamin D, Ca, vit A, thiazide diuretics, lithium can all cause….(stones, bones, abd groans, psychic overtones)

Answer 27

hyperCa and hyperPTH

stones - nephrolithiasis
bones - osteoporosis
abd - cramps, N/V/constipation
psychic - anxiety, depressed

Question 28

in what population are HbA1c readings inaccurate?

Answer 28

CKD!

HA, Sickle Cel, EPO therapy

Question 29

how can diabetic gomerulopnephropathy be prevented - add ___ class?

(all DM should be on this)

Answer 29

add ACE inhibitor (-prils) –> inhibits constriction of efferent renal arteriole

Question 30

edema, hypoalbuminemia, proteinuria >3g/d

Answer 30

diabetic Glomerulonephropathy with nephrotic syndrome

Question 31

most sensitive test for hypothyroid

Answer 31

1) serum TSH –> then do 2) T4

Question 32

94% specificity means…

Answer 32

94% of people w/o the disease test negative - it correctly assesses disease free pts 94% of the tie

Question 33

Tx of choice for hyperparathyroidism with osteoporosis

Answer 33

Parathyroid gland removal

Question 34

pre diabetes HbA1c range

Answer 34

5.7-6.4%

Question 35

hyperthyroid sx controlled with:

Answer 35

beta-blockers (i.e. -olol)

PTU adn methimazole are antithyroid, but take 2-8wks to reduce excess thyroid hormone production